Components of Situational Awareness in an Inpatient Psychiatric Milieu

Rates of violence and aggression continue to rise in psychiatric inpatient settings, and research has attempted to explore the problem from a variety of aspects from causation to intervention to impact on staff. Situational awareness (SA) has been applied and studied in multiple jobs and high-reliability organizations including medicine, but there is little information on its application to a psychiatric milieu.

There is limited information on the use of SA as an intervention for acts of aggression in psychiatric inpatient settings.

This article explores the use of SA to assist staff in developing recognition of a potential issue through the use of SA.

A subjectivist inductive approach is used starting with the open-ended question: "What does situational awareness look like on an inpatient psychiatric unit?" Data and theoretical understandings from multiple disciplines were reviewed to generate a framework to assist caregivers in recognizing and making intervention decisions.

An initial SA framework map was created that included 3 levels: elements, comprehension, and projection. Each level is discussed, and a graphic of the framework depicts the relationships among these levels and other key concepts related to SA.

The SA framework brings new thinking to current problems and interventions for violence and aggression. The framework will be further developed and tested for applicability to practice.